Ulcerative colitis

Question 1

What are the potential causes of UC?

Answer 1

SMOKING: Smoking is protective and those that quit smoking are more likely to have a relapse.
Ex smokers are 70% more likely to develop UC compared to those never smoked.

HYGEINE HYPOTHESIS: more hygienic environment growing up reduces exposure to bacteria and thus when exposed, the immune system is intolerant resulting in an aberrant response when exposed. US is more common in urban populations, smaller families, those from middle and upper class (reside in more sanitary surroundings).

ANTIBIOTIC USE: resulting in gut flora dysbiosis (children who receive ABs in first year of life are more likely to develop UC)

FAMILY HISTORY: 10-20% of individuals with UC have a first degree relative with UC. Twin studies, higher concordant disease rate in monozygotic compared with dizygotic pairs.

Question 2

What area of the colon is most commonly to least commonly affected by UC?

Answer 2

(In USA) Proctosigmoiditis (46%) > pancolitis (37%) > left sided colitis (17%)

Question 3

What are the symptoms of UC?

Answer 3

Urgency, diarrhoea, tenesmus, haematochezia.

These symptoms correlate with severity of disease.

Question 4

In addition to colon, what other organs are affected by UC?

Answer 4

Musculoskeletal, hepatopancreatobiliary, dermatological, thromboembolic, and opthalmological

Question 5

Which extraintestinal manifesation is reduced with surgical intervention (colectomy)?

Answer 5

Peripheral arthropathy, erythema nodosa, and iritis.

Question 6

Which extraintestinal manifestations continue independent of surgical intervention for UC?

Answer 6

Axial arthropathy, primary sclerosing cholangitis, uveitis, and episcleritis.